1. Physician Adoption of HIT: Barriers & Strategies AHRQ Annual Meeting Wednesday September 26, 2007 A. John Blair, III, MD President, Taconic IPA

2. Barriers Adoption & Long Term Use

3. Barriers  Wrong driver  Prohibitive cost  Inadequate IT expertise  Scarce resources  Limited resolve/tenacity  Poor integration of products  Unrealistic expectations

4. Wrong Drivers  Internal  Increase reimbursement  Save time  Cure for dysfunctional processes  “Techie” promoter  External  Hospitals  Health plans  RHIOs

5. Strategies  Automation after thoughtful redesign  Do not pave cow paths  Quality improvement  Improved safety  Patient satisfaction  Employee satisfaction  Practice desire not external promotion

6. Prohibitive Cost  $20,000-30,000/provider up-front  $500-1,000/provider/month on-going

7. Strategy  Subscription model  $5,000/provider up-front  $500/provider/month on-going

8. Inadequate IT Expertise  Practice management system  Legacy systems  Older technology  Less network complexity  Lower availability requirement  Lower response time requirement  Internet connectivity  ASP

9. Strategy  EHR is a new world  Availability  Response time  Equipment  Network

10. Strategy  IT support outsourcing  Connectivity  Healthcare setting  Application familiarity  New understanding of medical practice setting Now clinical area and workflow effected in addition to administrative  Preventive maintenance

11. Scarce Resources  Staffing constraints  Knowledge base

12. Ideal Implementation Vendor Practice

13. Strategy: Typical Implementation VendorPractice Gap Implementation Services

14.  Coordinate IT  Practice Consultant  MGMA Front office Billing office  Implementation  Project management  Post Implementation  CMIO  Decision support  Chronic disease management  Connectivity  HIE

15. Questions?

16. A. John Blair, III, MD President, Taconic IPA Thanks for your time!